Alcohol Research and Social Policy: An Overview.

Science can facilitate the task of choosing among complex social policies, although it rarely serves as the only basis for policy development. Science's role in policy formation can be decisive when public support already exists, as with the passage of the Federal Uniform Drinking Age Act. Science can assess a policy after it has been implemented, as in the scientific evaluation of the health warning labels on alcoholic beverage containers. In addition, science can investigate the short- and long-term benefits and risks of areas where the development of policies is likely. An example is the current scientific examination of the tradeoffs involved in moderate alcohol consumption.

local laws establishing penalties for drinking and driving.One example of a policy designed to increase public awareness of several specific health risks of alcohol consumption is the requirement for a health warning label on alcoholic beverage containers sold in the United States.Another policy is the requirement of individual States for mandatory sentencing of persons con victed of drinking and driving offenses.Some policies are designed to limit access to alcohol.Policies in this cate gory include raising the MLDA; re stricting the number, location, and business hours of alcoholic beverage sales outlets; and prohibiting the pro motion of alcoholic beverages on college campuses.In addition "dram shop" laws influence the drinking environment to help prevent adverse alcoholrelated consequences.These laws hold drinking establishments and, in some cases, private hosts liable for alcoholrelated damages caused by a person to whom they have served al coholic beverages.

Who Influences Policy Development?
Alcoholrelated policy development in the United States is complex.Federal, State, and local governments are in volved in regulation, and nongovern mental bodies, such as citizen and industry organizations, seek to influ ence policy directions.Federal Agencies.The major respon sibility for policy determination at the Federal level rests with the U.S. Con gress, which passes laws; the President, who signs laws; and the U.S. Supreme Court, which interprets laws.The re sponsibility for implementing Federal alcohol policies resides in several dif ferent Executive branch departments and agencies.For example, health warning labels on alcoholic beverage containers are regulated by the Depart ment of the Treasury and by the Fed eral Trade Commission.The Treasury Department also is responsible for administering Federal alcoholrelated tax policies and for collecting the as sociated revenues.Dietary guidelines containing recommendations on alco hol consumption are the joint respon sibility of the Departments of Health and Human Services (DHHS) and the United States Department of Agri culture (USDA).The USDA also is responsible for policies that affect agricultural production, including the production of grain and grape crops that are used in alcoholic beverages.
The Department of Transportation is concerned with alcoholrelated trans portation issues, including highway safety and the use of alcoholic bever ages by airplane pilots, railway workers, and ship personnel.Alcohol preven tion polices are under the purview of DHHS and the Departments of Trans portation (DOT) and Education.Al cohol treatment policies, including policies on health care reimbursement, are developed by DHHS and the De partments of Veterans Affairs (VA) and Defense (DOD), as well as by the Social Security Administration.
Research on alcoholrelated issues is undertaken by DHHS, the VA, DOD, and DOT; however, the primary agen cy devoted to alcohol research is the National Institute on Alcohol Abuse and Alcoholism (NIAAA), one of the National Institutes of Health located within DHHS.
As is apparent, policy and program coordination within this Federal struc ture is an ongoing necessity.Attempts have been made to establish standing interagency coordinating committees to promote consistency in Federal policy development.These committees, com prised of representatives of all Execu tive branch entities with alcoholrelated responsibilities meeting on a regular basis, proved less effective than hoped.Not every department has a role to play in the development or implementation of every policy and time spent by a large number of agencies on issues clearly not within their jurisdictions proved wasteful in terms of both time and programmatic accomplishment.Instead, coordination among Depart ments and agencies is effectively handled on a casebycase basis, with relevant parties coming together as necessary.Such was the case when the Bureau of Alcohol, Tobacco and Firearms (BATF), an agency of the

STATES' AND LOCAL GOVERNMENTS' ROLES IN ALCOHOL POLICY
States individually enact policies governing the following: • How alcohol is sold • Who may drink alcohol and where • Limits and penalties for the inappropriate use of alcohol • How and where alcohol is advertised within the State.
States' policy actions may be superseded by Federal actions.
States may share policy development with local governments.
States permit local governments to establish their own policies concern ing alcoholic beverage use.Participation by such nongovern mental entities can make the policy formulation process quite complex.At times, what is advocated by one set of private sector groups may con flict with the views of other private sector groups.For example, as noted above, advertising has been voluntarily regulated by the alcoholic beverage industry.A current policyrelated dis cussion concerns whether governmental restrictions should exist on the adver tising of alcoholic beverages, and if so, what they should be.Private sector groups representing a variety of opin ions both for and against restrictions are actively engaged in discussions in a variety of forums.Ultimately, these discussions, along with public opinion that they may generate and relevant scientific data, will form the basis for government action to establish or to decline to establish new policies gov erning alcohol advertising.

Interactions Among Multiple Levels.
Although the U.S. Constitution gives the States the authority to regulate the distribution, sale, and use of alcoholic beverages, the States must meet Federal criteria in this process.For example, al coholic beverage containers are required by Federal law to have health warning labels.The health warning messages, as well as the design and placement of the health warning label, are set forth in Federal law and regulation.
State laws also are subject to consti tutional review by the Federal courts.
In one recent instance, a group of in dustry representatives challenged a Rhode Island law prohibiting the ad vertising of alcoholic beverage prices, claiming that the ban infringed on their freedom of speech.In defending the constitutionality of this law before the U.S. Supreme Court, Rhode Island argued that the authority the 21st amendment to the U.S. Constitution grants to the States to regulate com merce in alcoholic beverages super sedes, for those engaged in the sale of alcohol, the 1st amendment guarantee of free speech.In its decision on the matter, 44 Liquormart v. Rhode Island (64 U.S.L.W. 4313 [1996]), the Court rejected this argument and struck down the restriction on price advertising on free speech grounds.How this ruling will ultimately affect other forms of advertising for alcoholic beverages remains to be seen.
Finally, the Federal Government can use the financial relationship it has with the States to foster the adoption of alcoholrelated policies.A prime exam ple of this interaction is the passage of the 1984 Federal Uniform Drinking Age Act, which tied the granting of monies from the Federal Highway Trust Fund to State passage of laws establishing the minimum legal drink ing age (MLDA) at 21 years.The Na tional Highway System Designation Act of 1995 provides a similar incen tive to the States to achieve a national "zerotolerance" policy.Under this leg islation, States must enact and enforce a law that considers a driver under the age of 21 with a blood alcohol con centration (BAC) of 0.02 percent or greater to be legally intoxicated.Any State that does not comply by 1999 will begin losing a portion of its Fed eral Highway Trust Fund share.

What Is the Role of Science in Policy Development?
Embodied in laws and regulations, public policies are usually developed when public concern over a problem has reached a critical level.Science can play a decisive role in policy de velopment when public support al ready exists, but rarely does science serve as the only basis on which policies are developed.A mix of economic, cul tural, religious, and political pressures is often more important to the process than scientific evidence for or against a particular policy.
How can science help?Occasion ally, strong evidence for a particular policy converges with sufficient pub lic support to effect a policy.Such is the case with the passage in 1984 of the Federal Uniform Drinking Age Act and the more recent passage of Federal legislation mandating zero tolerance policies in the States.In many cases, however, deciding which policies to implement is like deciding whom to marry-often one must make a decision before all the evidence is in.In these instances, science can still play a role by assessing a policy after it has been implemented.One exam ple is the scientific evaluation of the health warning labels on alcoholic beverage containers (discussed below).Science also can investigate the short and longterm benefits and risks of potential policies.The current scien tific examination of the benefits and risks of moderate alcohol drinking over the life span is an example of how science can contribute to the public dialog around issues that have the po tential to generate policy choices.

Raising the Minimum Drinking Age and Zero Tolerance: Using Science as a Resource in Policy Development.
Scientific evidence strongly influenced Federal efforts to encourage all States to adopt an MLDA of 21 years, as well as subsequent policies to encourage the States to adopt zerotolerance policies for underage drinkers.
The early 1970's (i.e., 1970 to 1975) brought about a trend among the States to lower the minimum age at which a person could purchase or possess al cohol.By the mid1970's, highway safety statistics began to show marked increases in alcoholrelated traffic deaths, particularly among young peo ple ages 16 to 24, who were heavily overrepresented among those who were dying on the highways.Public concern also was raised over the lack of consistency among State MLDA laws, which during the mid to late 1970's ranged from 18 to 21.In gener al, the concern was that inconsistencies in the States' laws created incentives for youth to cross State borders to pro cure alcohol in jurisdictions with lower MLDA's, thereby increasing their risks for alcoholrelated injury and death.Beginning in the mid1970's, many States began to raise their MLDA's.Studies of the impact of these changes found that raising the MLDA reduced alcoholrelated traffic crashes among young people affected by the law.Moreover, evidence indicated that these effects persisted over several years (O'Malley and Wagenaar 1991;Wagenaar 1993).
In 1984 the convergence of signifi cant public concern and a firm body of scientific evidence resulted in the passage of the Federal Uniform Drink ing Age Act, which called for all States to raise the MLDA to 21. Compliance by all 50 States was achieved in 1988.Research continues to show that an MLDA of 21 prevents drinkingand drivingrelated crashes and fatalities among drivers under 21.
More recently, science is serving as a resource in the national policy debate concerning underage drinking and alcoholrelated traffic fatalities among youth.Continuing concern about these issues has resulted in grow ing support for the passage of zero tolerance laws.These laws specify a maximum legal BAC of 0.02 or lower for drivers younger than age 21.States that enacted zerotolerance laws expe rienced an average 20percent reduc tion in fatal singlevehicle nighttime (SVN) crashes, compared with States that did not lower the legal BAC for underage drinkers.According to re searchers, if all States adopted these BAC limits for drivers ages 15 to 20, at least 375 fatal SVN crashes would be prevented each year (Hingson 1994).Continued public concern and support for strict measures to reduce underage alcohol use, coupled with the clear scientific evidence of the success of the MLDA law, has resulted in the passage or consideration of zerotolerance laws in a number of States, and as noted above, the passage of the Fed eral National Highway System Des ignation Act.

Health Warning Labels: Science
Can Help After Implementation.The coalescing of public support, rather than scientific evidence, resulted in the passage of legislation requiring health warning labels on alcoholic bev erage containers.Science, however, has been able to provide valuable in formation on how effective this partic ular policy has been both as a public information tool and as an instrument for changing behavior.
In 1988 legislation was enacted re quiring all alcoholic beverages (i.e., beer, wine, and distilled spirits) bottled on or after November 18, 1989, to carry a label warning the public of several significant health risks associated with alcohol use: birth defects (if alcohol is consumed during pregnancy), impair ment of ability to drive a car or oper ate machinery, and "health problems."The issue of an alcohol health warn ing label had been debated for nearly two decades, beginning in 1972 with bills introduced in the U.S. Senate that would have required a health warning label on distilled spirits.
A 1980 report issued jointly by the Department of the Treasury and DHHS summarized thencurrent scientific knowledge regarding birth defects and a wide range of other health hazards associated with alcohol consumption.This report noted that available evi dence with regard to cigarette and saccharin health warning labels sug gested that to be effective, health warn ing labels must be specific as to the risks that might be incurred.Because scientific evidence regarding the health risks of alcoholic beverages was lim ited, the report concluded that requir ing such labels on alcoholic beverage containers was premature.
By 1986, as a result of continuing public pressure, Federal legislation requiring health warning labels once more was introduced in both houses of Congress.As a part of the DHHS development of policy options and recommendations with respect to this legislation, NIAAA initiated a review of scientific literature on the effectiveness of health warning labels in communi cating risk and changing behavior.The review considered scientific evidence of the effectiveness of health warning labels for a variety of consumer prod ucts, such as tobacco and food, as well as for alcoholic beverages in countries other than the United States.Although supportive of alcohol health warning labels in principle, the conclusions of this review were more suggestive than definite.Based on the scientific evidence, the DHHS recommendation to Congress did not express support for health warning labels.
As happens often in the case of public policy debate, the public's belief in the value of health warning labels made the difference.For example, supporters of the measure argued that because health warning labels were required for bubble bath, aspirin, and other widely used products, they also should be required for one of America's most widely used and abused drugsalcohol.The intrinsic plausibility of such arguments was beyond dispute, despite the scant scientific evidence for the actual effectiveness of such labels.
The final passage of warninglabel legislation provided science with the opportunity to study the influence of the labels on public knowledge, atti tudes, and behaviors with regard to al cohol use.Although the warning labels do appear to have increased public awareness of the three alcoholrelated health risks described on the labels, they do not appear to have had a major influence on changing behavior (Hilton 1993).The above conclusions, provided by science the implementation of the policy, are available to help policy makers as they consider future options to reduce the consequences of alcoholic beverage consumption.Science Weighs Moderate Alcohol Consumption Before Policy Is Imple mented.Many studies show that mod erate alcohol consumption has some health benefits-specifically, it reduces the risk of cardiovascular disease.In postmenopausal women, lowlevel alcohol consumption also may enhance estrogen production, which in turn may provide protection from osteo porosis as well as from coronary heart disease (Tivis and Gavaler 1994).Yet, for some groups of people, moderate alcohol consumption also can increase the risk for alcoholrelated health prob lems, including adverse fetal effects and traffic crashes.Therefore, not just the quantity and frequency but also the timing of alcohol consumption may be important in weighing the risks and benefits of moderate drinking.
For example, although research has demonstrated cardioprotective benefits from moderate alcohol consumption, this benefit accrues from drinking over the life span and therefore mainly affects older drinkers.On the other hand, moderate drinking by younger persons, who generally are not at risk for heart disease, places them at in creased risk for alcoholrelated traffic fatalities.Members of the alcoholic bev erage industry frequently have requested Federal Government approval of label ing claiming the health benefits of moderate drinking.Such a policy, if implemented, not only might help reduce deaths from coronary disease but also might increase the risk of alcoholrelated traffic fatalities for younger persons.
Should moderate alcohol consump tion be encouraged or discouraged?By describing the health risks and benefits associated with different levels of al cohol consumption over the life span, science can provide critical information to help consumers make sensible deci sions about drinking.We need to know much more about the tradeoffs involved in moderate alcohol consumption, in cluding the following information: • A fuller understanding of who is at risk, and for what problems • Who stands to benefit from mod erate alcohol consumption and in what ways • How patterns of risks and benefits vary over the life span for various segments of the population.

CONCLUSION
Alcohol research has the potential to assist policy development and deci sionmaking.As our research base on alcoholrelated problems expands, public policy advocates, policymakers, and consumers will be better able to understand the potential impacts of their actions.As a result, they will be able to plan programs and implement public policy strategies that have the greatest chance to prevent and reduce alcoholrelated problems and to im prove overall health outcomes.■

FEDERAL GOVERNMENT DEPARTMENTS' ROLES IN ALCOHOL POLICY Health and Human Services (DHHS)
ages.Not only is each State free to develop its own policies, but many